Is
depression a decision?
Psychotherapist touts `directed thinking,' not drugs, as cure.

By
Snow Anderson
Special to the Tribune
Published May 15, 2002

"I
wake up feeling like I'm going to die in the morning. It's just
unbearable. It's agony."

This
is how A.B. Curtiss, author and psychotherapist, describes her
battle with depression. Yet Curtiss has never taken antidepressants.
Instead, she has written a book about her experience, "Depression
is a Choice: Winning the Battle Without Drugs" (Hyperion,
$24.95).

Curtiss,
a California family therapist, mother of five and grandmother
of nine, said the genesis of her depression lies in her childhood.
Her father was diagnosed with manic depression, as were she and
her brother. Her father eventually died in a state of catatonic
depression. Her brother has been taking medication for more than
20 years, Curtiss said, but it has not helped him. She went into
the field of psychotherapy to help herself find a cure for what
was running her life.

When
her book came out in October 2001, Curtiss said, she and the publisher
were convinced they had a best-seller on their hands. What she
has found instead is a hard sell.

"In
today's climate it is going against what people fervently believe
will save them: the pills, psychiatrists, psychology. So it's
a fearful idea that I'm saying these things will not cure you,"
she said.

Curtiss
does not diminish the devastating impact depression can have on
people's lives--she shares her own experience openly in the book--but
she does insist that drugs are not the answer.

Instead,
Curtiss offers "directed thinking" as a way to manage
depression. Because the mind can only think one thought at a time,
she explained, the trick becomes to distract the mind from thinking
about the depression and plug in a different thought.

"There
is only one reason we ever suffer with depression," Curtiss
writes in her book. "In order to suffer with depression,
we must think about ourselves and our pain. If we don't think
about ourselves and our pain, there is no way to suffer."

Curtiss'
suggestion for not thinking about feeling depressed is to use
techniques such as repeating a nursery rhyme, a prayer or mantra.
Saying "yes, yes, yes" over and over again, for example,
or repeating something as simple as, "Row, row, row your
boat." What happens by doing this is that we literally disconnect
the message that we are depressed from one part of the brain to
another, Curtiss said.

That
depression is caused by a chemical imbalance in the brain is a
fact that need not frighten us, she said.

"There
are two parts of your brain, the neocortex and the subcortex.
You produce emotion in the subcortex--panic, fear, whatever. However,
the neocortex has to receive the message that you are undergoing
those feelings. Neurotransmitters from the subcortex send messages
to the neocortex, and you receive cognitively the idea that you
are now feeling that feeling."

What
she does by inserting the repetitive thoughts, Curtiss said, is
block the signal.

"I'm
jamming that section of the neocortex that's receiving the feelings
that I'm depressed, until such time as the chemistry balance changes
and those feelings are no longer produced in the subcortex. I
am doing it cognitively, in the neocortex, what the pills [antidepressants]
and the electric shock do to the subcortex. They are destroying
those feelings. I'm not destroying them, I am distracting that
part of the neocortex that is receiving the message that those
feelings have been produced."

In
order to implement Curtiss' program of directed thinking, a person
would have to be motivated to make that choice. Critics would
argue that the problem with depression is that it can rob people
of feeling they have a choice.

Curtiss
disagrees: "They always have a choice, they are never bereft
of choice. What they are bereft of is motivation, and that is
what needs to be supplied."

She
suggests in her book that a program be prepared in advance, so
that when a person begins to feel the onset of depression, they
already have a plan in place. "It's like a pill, except my
pill is motivation. Here's this little bottle and in here is your
program of what you're going to do when you get depressed."

Curtiss
acknowledged that the person who is experiencing depression is
not going to feel like doing this. But the reason to do it, she
said, is because "it is the answer to your depression. You
decide ahead of time what you're going to do," in a sense,
providing your own motivation, though, she explained, it's not
really motivation. "It's a substitute for the motivation
that you lack. When you do it, it gets you out of depression,
and then your motivation will reassert itself."

Chicago
clinical psychologist, Dr. Angelique Sallas, said that though
Curtiss' theory is plausible, treating depression is far more
complex than just applying a mantra, because, she explained, "you
don't just find easily something that's kind of pure depression."

Sallas,
whose specialty is treating people with eating disorders, said
those patients, for example, also have obsessive-compulsive components,
depression and anxiety.

"So
you really have to look at interaction," she said. "You
cannot just say, `Gee, if I just say this mantra I'm going to
distract myself and somehow that's going to alleviate my depression.
Yes, you can distract yourself if you utilize certain cognitive,
behavioral methods to try to cope with it, particularly if it's
a milder form of depression, and you can pull out. There are other
times that you can't climb out from underneath the covers. And
to treat it, you need both [therapy and medication]."

Sallas
was practicing long before antidepressants were available, so
she learned to work with people without medication. But that,
she said, was a tougher road.

"It
was harder on the person," she explained. "It doesn't
mean that they couldn't get through certain things, but you know,
you have a suicidal person, you don't want to play games. You've
got to alleviate some of that depression before you can help them
behaviorally."

Dr.
Brad Saks, an Evanston psychologist concurs with Sallas.

"My
experience certainly is that mild to moderate depression can most
definitely be managed without medication, using good cognitive
therapy. However, I think it's also clear that once you get into
more severe cases, when people are experiencing a lot of the vegetative
symptoms of depression, where it's hard for them to get out of
bed in the morning and they're having a hard time just motivating
and activating, that medication in lots of cases is indicated,
simply because it provides people with a way to get better faster."

At
the same time, Saks sees value in Curtiss' theory.

"I
don't know if I agree with all of her model, but I certainly do
agree that the mind and body are obviously quite connected and
that by talking to yourself differently or by using techniques
such as relaxation or meditation, you literally can bring about
physiological changes."

Saks
made an analogy between his work with patients who suffer from
chronic pain and what Curtiss proposes in her book.

"Some
of the work on chronic pain is what we call the gate-control theory.
What it says is, you have pain responses that are mediated from
your body through your spinal cord up into your brain and then
they're registered as pain. This theory says if you use things
like relaxation, or the saying of a mantra, or something of that
nature, or different cognitive techniques, then you can block
those sensations, which I think is very similar to what she's
saying," Saks said.

Ultimately
however, when it comes to treating depression, Sallas said, "If
there were one way, and it was the way, the truth and the light,
we'd all be doing it. The reality is you have to take into account
the individual, the dynamics of that particular individual, their
presenting symptomatology and this whole bag of stuff that you
draw from, including medication, to try and help that person."

"I
think we're ethically bound to use whatever tools are available,
and I think a combination of good therapy and medication, particularly
for more severe cases, can go a long way toward helping people
more rapidly," Saks said.

Curtiss,
however, maintains that anyone can be pulled out of depression
with enough commitment.

"I've
had psychiatrists tell me, `I have people that are so depressed
they're in a wheelchair.' Well, my thought would be, you pick
that person up out of the wheelchair, you put your arms around
them and you make them take a walk. You actually make people physically
start moving and that alone will start something favorable happening
for them," she said.